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目的了解2009年驻京部队入伍新兵结核感染及发病情况,评价酶联免疫斑点试验(ELISPOT)在检测结核分枝杆菌感染中的应用价值。方法 2009年907例驻京部队入伍新兵,行胸部X线检查、PPD皮肤试验和ELISPOT检测。PPD皮肤试验阴性者,接种卡介苗7个月后抽查110例,再进行PPD皮肤试验和ELISPOT检测。随访18个月了解结核病发病情况。结果 907例入伍新兵中,PPD皮肤试验和ELISPOT的阳性率分别为50.2%和30.7%。452例PPD阴性和455例PPD阳性者中,分别有132例(29.2%)和146例(32.1%)ELISPOT阳性,两者的一致率为51.4%(466/907)。65.6%的PPD阳性者和27.8%的ELISPOT阳性者[斑点形成细胞(SFC)12.2±21.2]有卡介苗接种;21.3%的PPD阳性者和35.9%的ELISPOT阳性者(SFC 18.3±34.6)没有卡介苗接种。PPD皮肤试验阴性的新兵接种卡介苗7个月后抽查的110例中,85例(77.3%)PPD皮肤试验阳性、21例(19.1%)强阳性,21例(19.1%)ELISPOT阳性、13例(11.8%)强阳性;两者的一致率为38.2%(42/110)。12例新兵发现胸片异常,其中12例(100%)PPD皮肤试验阳性,6例(50%)ELISPOT阳性。随访18个月,均未发现发展为结核病。结论驻京部队入伍新兵的结核感染率低于既往报道,提示卡介苗接种能部分保护人群抵抗结核感染,ELISPOT技术能够更有效地筛查结核感染。
Objective To understand the prevalence and incidence of tuberculosis among military recruits in Beijing in 2009 and evaluate the value of ELISPOT in detection of Mycobacterium tuberculosis infection. Methods In 2009, 907 recruits from Beijing stationed in Beijing performed chest X-ray, PPD skin test and ELISPOT. PPD skin test negative, 7 months after vaccination BCG spot check 110 cases, then PPD skin test and ELISPOT test. Follow-up 18 months to understand the incidence of tuberculosis. Results Among 907 recruits, the positive rates of PPD skin test and ELISPOT were 50.2% and 30.7% respectively. Among 452 cases of PPD negative and 455 cases of PPD positive, 132 (29.2%) and 146 (32.1%) ELISPOT were positive respectively, with a concordance rate of 51.4% (466/907). BCG vaccination occurred in 65.6% of PPD-positive individuals and 27.8% of ELISPOT-positive individuals (spot-forming cells (SFC) 12.2 ± 21.2]; no BCG vaccination occurred in 21.3% of PPD-positive individuals and 35.9% of ELISPOT-positive individuals (SFC 18.3 ± 34.6) . Eighty-one (77.3%) PPD skin tests were positive, 21 (19.1%) were positive, 21 (19.1%) were ELISPOT-positive and 13 (77.1%) were positive after PPM test. 11.8%). The agreement rate between them was 38.2% (42/110). Twelve recruits were found to have an abnormal chest radiograph, with 12 (100%) PPD skin tests positive and 6 (50%) ELISPOT positive. During 18 months of follow-up, no development of tuberculosis was found. Conclusions The TB infection rate of recruits in Beijing is lower than previous reports, suggesting that BCG vaccination can partially protect the population from tuberculosis infection. ELISPOT can screen tuberculosis infection more effectively.